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1.
Acta Pharmaceutica Sinica ; (12): 200-210, 2022.
Article in Chinese | WPRIM | ID: wpr-913169

ABSTRACT

Chemoimmunotherapy has attracted much attention as an emerging therapy pattern for the treatment of cancers. Exploring effective drug combination schemes and reasonable delivery methods remained the key issue in current research. Herein, we designed sorafenib (SF) and anti-Tim-3 monoclonal antibody (Tim-3 mAb) co-loaded MMP2-responsive mesoporous silica nanoparticles (ST-MSNs) for combined chemoimmunotherapy of hepatocellular carcinoma (HCC). The shell of ST-MSNs was fabricated by Tim-3 mAb through matrix metalloproteinase 2 (MMP2) sensitive peptides as "gatekeepers" to prevent drug release during the blood circulation. In tumor microenvironment, the high levels of MMP2 caused the responsive shedding of Tim-3 mAb, leading to the triggerred release of SF and Tim-3 mAb. Then, SF could be delivered to tumor cells and Tim-3 mAb could be delivered to T cells, respectively. In vivo tumor inhibition study results demonstrated that ST-MSNs can significantly enhance synergistic antitumor activity compared with sequential administration of free SF solution and Tim-3 mAb solution. Meanwhile, the expression of antitumor cytokines IFN-γ, IL-12 and the percentage of CD3+CD4+ cells, CD3+CD8+ cells in tumors were upregulated after the administration of ST-MSNs, demonstrating good immunomodulatory ability. In addition, within the dosage range, the ST-MSNs had low cytotoxicity and hemolysis, and no obvious tissue toxicity was observed. All animal experiments were performed in line with national regulations and approved by the Animal Experiments Ethical Committee of Shandong University. In conclusion, this study provided a promising drug combination of chemoimmunotherapy with good application prospects for clinical HCC treatment, and exhibited a potential drug carrier for clinical chemoimmunotherapy.

2.
International Eye Science ; (12): 340-342, 2022.
Article in Chinese | WPRIM | ID: wpr-913050

ABSTRACT

@#AIM: To observe the location characteristics of the earliest tear film breakup in elderly patients with dry eyes.METHODS: Cross-sectional study. The 154 elderly patients with dry eyes in our hospital from July 2019 to December 2019 were included, with 143 right eyes, 124 left eyes, and 71 patients were males, 83 patients were females, aged 68-90(mean: 73.40±4.13)years old. The location of the earliest tear film breakup was investigated by using corneal topographer. The cornea was separated to four sectors to record the earliest tear film breakup location by anticlockwise order. The sector corresponding to the right eye was nasal superior, temporal superior, temporal inferior and nasal inferior respectively. And it corresponding to the left eye was temporal superior, nasal superior, nasal inferior and temporal inferior respectively. Then the sector which was the earliest tear film breakup location was recorded. At the same time, the distance which was from the earliest tear film breakup location to the centre of cornea was recorded too.RESULTS: The highest constituent ratio of area of right eye was nasal inferior(28.7%), then was temporal inferior(27.3%), nasal superior(20.3%), temporal superior(11.2%), and the constituent ratio of earliest tear film breakup occurred in 2-3 areas at the same time was 12.6%. The constituent ratio of the earliest tear film breakup area of left eye also was nasal inferior(31.5%), then was temporal inferior(25.0%), nasal superior(23.4%), temporal superior(11.3%), the constituent ratio of earliest tear film breakup occurred in 2-3 areas at the same time was 8.9%. There was no difference in the constituent ratio of tear film breakup area between two eyes(χ2=1.443, <i>P</i>=0.837). The distance from the earliest tear film breakup area of the nasal inferior quadrant to the centre of cornea was mostly the zone from 1.5-2mm and 2-2.5mm in both eyes.CONCLUSION: There is a certain regularity in the characteristics of tear film breakup area in elderly patients with dry eyes, and the earliest tear film breakup area of both eyes is mainly occurred in nasal inferior, and there is no significant difference between two eyes.

3.
Article in English | WPRIM | ID: wpr-914654

ABSTRACT

Background and Objectives@#Manipulating different signaling pathways via small molecules could efficiently inducecardiomyocytes from human induced pluripotent stem cells (hiPSC). However, the effect of transcription factors on the hiPSC-directed cardiomyocytes differentiation remains unclear. Transcription factor, p53 has been demonstrated indispensable for the early embryonic development and mesendodermal differentiation of embryonic stem cells (ESC).We tested the hypothesis that p53 promotes cardiomyocytes differentiation from human hiPSC. @*Methods@#and Results: Using the well-characterized GiWi protocol that cardiomyocytes are generated from hiPSC via temporal modulation of Wnt signaling pathway by small molecules, we demonstrated that forced expression of p53 in hiPSC remarkably improved the differentiation efficiency of cardiomyocytes from hiPSC, whereas knockdown endogenous p53 decreased the yield of cardiomyocytes. This p53-mediated increased cardiomyocyte differentiation was mediated through WNT3, as evidenced by that overexpression of p53 upregulated the expression of WNT3, and knockdown of p53 decreased the WNT3 expression. Mechanistic analysis showed that the increased cardiomyocyte differentiation partially depended on the amplified mesendodermal specification resulted from p53-mediated activation of WNT3-mediated Wnt signaling. Consistently, endogenous WNT3 knockdown significantly ameliorated mesendodermal specification and subsequent cardiomyocyte differentiation. @*Conclusions@#These results provide a novel insight into the potential effect of p53 on the development and differentiation of cardiomyocyte during embryogenesis.

4.
Article in Chinese | WPRIM | ID: wpr-912524

ABSTRACT

It is an urgent need for the development of medical and health undertakings in the new era to build a high-quality university education system and cultivate high-quality personnel for laboratory medicine. In the process of building a national first-class specialty, the medical laboratory technology specialty of Southern Medical University adheres to the concept of high-quality university education and improves the training level of laboratory medicine personnel through the teaching reform practice of constructing the whole-process moral education system, systematical training mode, internationalized teaching team, and intelligent teaching technology. In this paper, we analyzed the connotation and construction experience of a high-quality university education system of laboratory medicine, in order to increase the exchange and communication between different colleges and universities, and make contributions to the national strategic goal of building a powerful country in education before 2035.

5.
Article in Chinese | WPRIM | ID: wpr-912394

ABSTRACT

Objective:To observe the efficacy of conbercept in the treatment of different types of diabetic macular edema (DME).Methods:A retrospective clinical study. From March 2019 to March 2021, 136 eyes of 136 patients with DME diagnosed in Department of Ophthalmology of Xi'an No.3 Hospital were included in the study. Among them, there were 65 males and 71 females; the average age was 56.65±8.65 years. All patients underwent best corrected visual acuity (BCVA), optical coherence tomography (OCT) examination, and glycosylated hemoglobin level (HbA1c) examination. Early Treatment Diabetic Retinopathy Study visual acuity chart was used for BCVA examination, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistics. An OCT instrument was used to measure the central retinal thickness (CRT) of the macula. According to the characteristics of OCT, DME was divided into diffuse retinal thickening (DRT) type, cystoid macular edema (CME) type, serous retinal detachment (SRD) type, mixed type, and grouped accordingly, respectively, about 30, 38, 33, 35 eyes. There was no significant difference in age ( F=1.189), sex ratio ( χ2=1.331), and HbA1c level ( F=3.164) of the four groups of patients ( P>0.05). All eyes were treated with intravitreal injection of 10 mg/ml conbercept 0.05 ml (including conbercept 0.5 mg) once a month for 3 consecutive times, and then treated as needed after evaluation. BCVA and OCT examinations were performed 1, 3, and 6 months after treatment with the same equipment and methods as before treatment. The changes of BCVA and CRT before and after treatment were compared and observed. For measurement data subject to normal distribution, one-way analysis of variance was performed for comparison between groups; χ2 test was performed for comparison of count data. Results:Before treatment, the logMAR BCVA of the eyes in the DRT group, CME group, SRD group, and mixed group were 0.68±0.11, 0.69±0.15, 0.71±0.12, 0.73±0.14, and CRT was 631.4±50.7, 640.6±55.7, 652.3±63.4, 660.4±61.8 μm. Compared with before treatment, 1, 3, 6 months after treatment, DRT group (BCVA: t=8.139, 11.552, 11.672; CRT: t=16.163, 21.653, 25.855), CME group (BCVA: t=8.923, 9.995, 13.842; CRT: t=16.163, 21.653, 25.855), SRD type group (BCVA: t=5.171, 7.315, 6.051; CRT: t=9.099, 13.731, 21.306), mixed type group (BCVA: t=5.072, 6.939, 7.142; CRT: t=6.920, 15.352, 17.538) The BCVA of the affected eyes was significantly increased, and the CRT was significantly decreased, and the difference was statistically significant ( P<0.05). At 6 months after treatment, the differences in logMAR BCVA and CRT of the 4 groups of eyes were statistically significant ( χ2=58.478, 64.228; P<0.05). The average number of injections in the eyes of the DRT group, CME group, SRD group, and mixed group were 3.37±1.35, 3.68±1.38, 4.18±1.40, 4.13±1.50 times, respectively. Compared with the average number of injections in the eye, the difference was statistically significant ( χ2=9.139, P=0.028). Conclusions:Conbercept can effectively reduce CRT and increase BCVA in eyes with different types of DME. Compared with SRD type and mixed type, DRT and CME type eye are more effective in improving vision, CRT reduction degree is greater, and the number of injections is less.

6.
Article in Chinese | WPRIM | ID: wpr-912316

ABSTRACT

Objective:To explore the efficacy and safety of neoadjuvant chemoimmunotherapy combined with surgery for stage ⅢA NSCLC patients.Methods:Six patients with NSCLC who were diagnosed as ⅢA and received two cycles of neoadjuvant chemoimmunotherapy and surgery between September 2019 and January 2020 were described in this study.Results:Five of them experienced AEs during neoadjuvant therapy. All of them received surgery and achieved an MPR of 50%. No viable tumor cells were found in the tissues of one patient. One patient with a small bronchopleural fistula after lobectomy.Conclusion:Neoadjuvant chemoimmunotherapy combined with surgery for stage ⅢA NSCLC patients is safe and efficient. Long-term outcomes of neoadjuvant chemoimmunotherapy combined with surgery should be further validated.

7.
Chinese Journal of Neurology ; (12): 696-699, 2021.
Article in Chinese | WPRIM | ID: wpr-911779

ABSTRACT

Spinocerebellar ataxias (SCAs), formerly known as autosomal dominant cerebellar ataxia, are a group of hereditary heterogeneous neurodegenerative disease that contains many subtypes. Spinocerebellar ataxia type 23 (SCA23), one type of SCAs, is caused by mutant prodynorphin (PDYN) gene. A 22-year-old patient was diagnosed with sporadic SCA23 due to gene detection, with a novel identified mutation, PDYN c.647C>T (p.P216L). Located in the dynorphin A-coding-region of PDYN gene, the pathogenic mechanism of the mutation may be relevant to the pathological changes caused by the variant including neurological dysfunction and death of cells. Mild improvement with the patient has been witnessed after active balance and speaking exercise.

8.
Chinese Journal of Urology ; (12): 535-539, 2021.
Article in Chinese | WPRIM | ID: wpr-911064

ABSTRACT

Objective:To summarize long-term outcome of sacral neuromodulation (SNM) for refractory interstitial cystitis/bladder pain syndrome (IC/BPS).Methods:Between January 2013 and October 2020, 28 patients with IC / BPS who received SNM in Beijing Chaoyang Hospital and Hebei Yanda Hospital were retrospectively analyzed. There were 5 males and 23 females, with median age 63.00 (47.50, 66.75) years old. The urgency score was 4 (3, 4) points, 24-hour micturition frequency was 26 (20.50, 32.50) times, nocturia was 9 (7, 12) times, single urine volume was 59.00 (41.25, 79.50) ml, VAS score was 9.0 (8.0, 9.0) points, O′Leary-Sant score was 31.00 (20.25, 33.00) points, and single maximum urine volume was 100.0 (80.0, 127.5) ml. The improvement of symptoms before operation, test period and last follow-up were compared.Results:The urgency score was 2 (1, 3), the 24-hour micturition frequency was 17.00 (15.00, 22.75), the frequency of nocturia was 5.5 (4.0, 7.0), the single urine volume was 87.50 (70.25, 110.00) ml, the VAS score was 4.0 (3.0, 6.0) and the O′Leary-Sant score was 20.00 (17.00, 23.00) in 28 patients during the test period, which were significantly improved compared with those before operation ( P < 0.05). There was no significant difference in the single maximum urine volume of 135.0 (102.5, 160.0) ml between the two groups ( P > 0.05). 28 patients received SNM Ⅱ permanent stimulator implantation. The median follow-up time was 29.5 (21.25, 61.75) months. Among the 28 patients, 3 patients underwent cystectomy and ileal conduit after removal of the complete SNM system due to the unsatisfied results. Twenty-five cases (89.3%) were still treated with SNM. Among them, 6 cases accepted combinative therapy of oral medicine (antihistamines, sodium pentose polysulfate, hormones, immunosuppressants, etc.). Two cases accepted combinative therapy of intravesical instillation, including heparin in one case and sodium hyaluronate in the other one. Three cases accepted combinative therapy of botulinum toxin injection.One case accepted combinative therapy of bladder augmentation. Two cases accepted combinative therapy of traditional Chinese medicine (TCM). One case accepted combinative therapy of oral medicine and TCM. The remaining 10 cases didn't accept any treatment. Among them, 3 cases were still treated with SNM even though they were not satisfied with the effect, including 1 case due to electrode displacement. At the last follow-up of 25 patients, the urgency score was 2 (1, 3), the 24-hour micturition frequency was 16.50 (13.00, 19.75), the frequency of nocturia was 5.5 (4.0, 9.0), the single urine volume was 105.0 (72.5, 120.0) ml, the VAS score was 4.5 (3.0, 6.0) and the O'Leary Sant score was 16.00 (14.00, 22.50), which were significantly improved compared with those before operation ( P < 0.05), but no difference with those during test period ( P>0.05). There was no significant difference in the single maximum urine volume of 125.0 (102.5, 150.0) ml at the last follow-up compared with preoperative and test period ( P>0.05). Conclusions:As a treatment option for refractory IC / BPS, SNM can improve the symptoms of most patients and maintain good long-term efficacy combined with other.

9.
Chinese Journal of Urology ; (12): 443-448, 2021.
Article in Chinese | WPRIM | ID: wpr-911047

ABSTRACT

Objective:We compare the consistency, similarities and differences of operating procedures, data and conclusions of air-charged catheters(ACC) and water-filled catheters(WFC), as simultaneously using ACC and WFC in pressure-flow study(PFS).Methods:This study was a prospective, synchronously controlled study, including eligible patients who underwent PFS in the Department of Urology, Beijing Chaoyang Hospital from January 2021 to March 2021. Inclusion criteria: ① Patients need PFS for lower urinary tract symptoms like frequency of urination, urgent urination, urinary incontinence and dysuria; ② Age over 18 years old. Exclusion criteria: ① Unable to complete or cooperate during the urodynamic test; ② Patients with severe urethral stricture or acute stage urinary tract infection; ③ Pregnant women. The bladder pressure was measured continuously by using a 7FDR T-DOC ?AC three-chamber bladder pressure tube, which linked to ACC sensor and improved WFC pressure conduction module. At the same time, 7FA T-DOC ?AC single-lumen rectal pressure tube and 7F Labori-CAT411 double-lumen water sac abdominal pressure tube was used to measure the ACC and WFC rectum pressure, respectively. We recorded the Pdet, Pves and Pabd measured by ACC and WFC, at the point of initial sitting position, bladder filling at 100 ml, 150 ml, 200 ml, cough, Q max, maximum Pdet and the end of urination, and compared the mean values, differences, and consistencies of our data. Result:A total of 63 patients (26 female, 37 male) were included in this study, with an average age of 59.19 years (25-86 years old). During bladder filling phase, the mean values of Pves measured by ACC and WFC were 30.78/24.67cmH 2O (initial sitting position), 29.79/25.13cmH 2O (100 ml), 30.87/25.90cmH 2O (150 ml) and 30.95/26.17cmH 2O(200 ml), respectively, the mean value of Pabd were 30.03/24.17cmH 2O (initial sitting position), 28.81/21.78cmH 2O (100ml), 28.89/21.38cmH 2O (150ml), 28.44/21.60cmH 2O (200ml), respectively, and were significantly different at each sampling point ( P<0.01). During urination period, no significant differences were found in data( P>0.05), and the data measured with ACC and WFC system have good consistency. There were significant differences in Pves(mean 57.30/49.95 cmH 2O, respectively) and Pdet(mean 54.21/43.10 cmH 2O, respectively) between ACC and WFC in cough ( P<0.01), but there was a strong linear correlation between these data between two systems(R 2=0.792 in Pves and 0.756 in Pabd). Bland-Altman analysis showed that detrusor pressure at the maximum urine flow rate maintained good consistency between ACC and WFC, which 95% CI was -13.9 cmH 2O to 15.8 cmH 2O. Conclusions:In PFS, although the ACC measurement values (Pves and Pabd) during the filling phase are higher than those WFC readings, but the absolute measurement difference is small, so there is no practical meaning in clinical practice. There was no significant difference in detrusor pressure measured during voiding phase, which indicated that the urodynamic judgment and clinical conclusions of the two systems are highly consistent in judgment of the detrusor contractility and the bladder outlet obstruction.

10.
Chinese Journal of Urology ; (12): 414-422, 2021.
Article in Chinese | WPRIM | ID: wpr-911043

ABSTRACT

Objective:To assess the efficacy and safety of 100 units of botulinum toxin A (BTX-A) intradetrusor injection in patients with overactive bladder.Methods:From April 2016 to December 2018, 17 tertiary hospitals were selected to participate in this prospective, multicenter, randomized, double-blind, placebo-controlled study. Two phases of study were conducted: the primary phase and the extended phase. This study enrolled patients aged 18 to 75 years who had been inadequately managed by anticholinergic therapy (insufficient efficacy or intolerable side effects) and had spontaneous voiding with overactive bladder. Exclusion criteria included patients with severe cardiac, renal and hepatic disorders, patients with previous botulinum toxin treatment for 6 months or allergic to BTX-A, patients with urinary tract infections, patients with urinary stones, urinary tract tumors, diabetes mellitus, and bleeding tendency. Eligible patients were randomly assigned to BTX-A group and placebo control group in a ratio of 2∶1. Two groups of patients received 20 intradetrusor injections of BTX-A 100U or placebo at the depth of the submucosal muscle layer respectively under cystoscope, including 5 injections at the base of the bladder, 3 injections to the bladder triangle, 5 injections each to the left and right walls and 2 injections to the top, sparing the bladder neck. As a placebo control group, patients received same volume of placebo containing no BTX-A and only adjuvant freeze-dried preparations for injection with the same method. A combination of gelatin, sucrose, and dextran served as adjuvants. Average micturition times per 24 hours, urinary incontinence (UI) episodes per day, average micturition volume per day, OAB symptom score(OABSS), and quality of life (QOL) score were recorded at baseline and the 2nd, 6th and 12th week after treatment. The primary efficacy endpoint was the change from baseline in the average micturition times per 24 hours at the 6th week after treatment. The secondary efficacy endpoints included the change from baseline in the average micturition times per 24 hours at 2nd and 12th week, as well as the change from baseline in the OABSS, QOL score, average frequency of urgency and UI episodes per day, urgency score, average micturition volume per day at 2nd, 6th and 12th week after treatment. Patients were followed for 12 weeks to assess adverse events (AEs). After assessed at week 12, if the micturition times has decreased less than 50% compared to baseline and the patient is willing to receive retreatment, then patients could enter the extended trial phase. In that phase, patients in both groups were injected with 100 units BTX-A from 12th week onwards and then followed up the same indicators for 12 weeks.Results:216 patients were enrolled in this trial (144 cases in the BTX-A group and 72 cases in the placebo control group). Baseline characteristics such as age (47.75±14.20 in the BTX-A group and 46.39±15.55 in the control group), sex (25 male/117 female in the BTX-A group and 10/61 in the control group), and disease duration (0.51 years in the BTX-A group and 0.60 years in the control group) were balanced between the two groups( P>0.05). A marked reduction from baseline in average micturition times per 24 hours was observed in all treatment groups at the 6th week and the reduction of the two groups was statistically different ( P<0.001 and P=0.008 respectively). Compared with the baseline, the average micturition times per 24 hours at the 6th week decreased from baseline by 2.40(0.70, 4.60)times for the BTX-A group and 0.70(-1.00, 3.30) times for the placebo control group respectively, and the difference between the two groups was considered to be statistically significant ( P=0.003). The change rates of average micturition times per 24 hours from baseline at the 6th week of the two groups were (16±22)% and (8±25)% respectively, and the difference between the two groups was statistically significant ( P=0.014). Compared with the baseline, the average micturition times per 24 hours at 2nd and 12th week decreased by 2.00(0.00, 4.00)and 3.30(0.60, 5.03)for the BTX-A group, 1.00(-1.00, 3.00)and 1.70(-1.45, 3.85)for the placebo control group respectively. The difference between two groups was considered to be statistically significant ( P=0.038 and P=0.012); the changes of average urgency times per day for the BTX-A group and the control group at the 2nd, 6th and 12th week were 2.00(0.00, 4.30)and 2.40(0.30, 5.00), 3.00(0.30, 5.70)and 0.70(-1.30, 2.70), 0.70(-1.30, 3.00) and 1.35(-1.15, 3.50), respectively. There were significant differences between two groups at the 2nd, 6th and 12th week, ( P=0.010, P=0.003 and P=0.025, respectively). The OABSS of the BTX-A group and the control group at the 6th week decreased by 1.00(0.00, 4.00)and 0.50(-1.00, 2.00) compared with the baseline, and the difference between the two groups was statistically significant ( P=0.003). 47 cases of BTX-A group and 34 cases of placebo control group entered the extended trial phase, and 40 and 28 cases completed the extended trial phase, respectively. The average micturition volume per 24 hours changed by -16.60(-41.60, -0.60)ml and -6.40(-22.40, 13.30)ml, (-35.67±54.41)ml and(-1.76±48.69)ml, (-36.14±41.51)ml and (-9.28±44.59)ml, (-35.85±43.35)ml and(-10.41±40.29)ml for two groups at the 12th, 14th, 18th and 24th week, and the difference between two groups was statistically significant at each follow-up time ( P=0.01, 0.006, 0.012 and 0.016, respectively). There was no significant difference in other parameters( P>0.05). However, adverse reactions after intradetrusor injection included increased residual urine volume (27 in the BTX-A group and 3 in the control group), dysuria (21 in the BTX-A group and 6 in the control group), urinary infection (19 in the BTX-A group and 6 in the control group), bladder neck obstruction (3 in the BTX-A group and 0 in the control group), hematuria (3 in the BTX-A group and 1 in the control group), elevated alanine aminotransferase (3 in the BTX-A group and 0 in the control group), etc. During the follow-up period, there was no significant difference in the other adverse events between two groups except the increase of residual urine volume( P<0.05). In the primary trial phase, among the 27 cases with increased residual urine volume in BTA group, only 1 case (3.70%) with PVR more than 300 ml; the PVR of 3 patients in the placebo group was less than 100 ml. The increase of residual urine volume caused by the injection could be improved or disappeared with the passage of time. Conclusions:Intradetrusor injection of Chinese BTX-A improved the average micturition times per 24 hours, the average daily urgent micturition times, OABSS, and average micturition volume per time, and reduced the adverse effects in patients with overactive bladder.Chinese BTX-A at dose of 100U demonstrated durable efficacy and safety in the management of overactive bladder.

11.
Article in Chinese | WPRIM | ID: wpr-910892

ABSTRACT

Objective:To analyse the pathogenic bacteria distribution and clinical characteristics of late-onset sepsis (LOS) among premature infants with gestational age less than 34 weeks in Henan Province.Methods:The clinical data of 6 590 premature infants admitted to 17 medical institutions in Henan Province from January 2019 to December 2020 were retrospectively analyzed. The gestational age of infants was less than 34 weeks and was admitted to the neonatal ward within 7 days after birth. SPSS 19.0 statistical software was used for data analysis.Results:Among 6 590 premature infants LOS developed in 751 cases (11.40%), of whom the diagnosis was confirmed in 276 cases (36.75%) and 475 cases (63.25%) were diagnosed clinically. The fatality rate related to LOS was 13.58%. There were significant differences in the incidence of LOS and infection-related mortality among infants with different gestational ages and body weights ( χ2=388.894 and 13.572, χ2=472.282 and 9.257, P<0.05 or <0.01). Among 276 children with confirmed LOS, 286 strains of pathogenic bacteria were isolated. Gram-negative bacteria were most prevalent (178 strains), accounting for 62.24% of all infections, followed by fungi (58 strains, 20.28%). Klebsiella pneumoniae was most frequently detected Gram-negative bacteria (117 strains, 40.91%), among which 32.48% (38/117) was carbapenem-resistant Klebsiella pneumoniae. The proportion of diagnosed sepsis, the proportion of catheterization, and the infection-related mortality of infants with LOS in tertiary hospitals were all higher than those in secondary hospitals ( χ2=6.212, 5.313 and 4.435, all P<0.05). The proportion of exclusive breastfeeding in secondary hospitals was lower than that in tertiary hospitals ( χ2=19.216, P<0.05). The time of antibacterial drug use before infection in specialized hospitals was longer than that in general hospitals ( χ2=3.276, P<0.05). Conclusion:The incidence of LOS among preterm infants in Henan Province is high, which was mainly caused by Gram-negative bacteria. The clinical characteristics of LOS caused by different pathogens and in different health institutions are different, the prevention and control strategy should be developed accordingly to reduce the incidence LOS of preterm premature infants.

12.
Chinese Journal of Trauma ; (12): 825-832, 2021.
Article in Chinese | WPRIM | ID: wpr-909945

ABSTRACT

Objectives:To investigate the nursing effect of perioperative enhanced recovery after surgery(ERAS)management model in elderly patients with hip fracture.Methods:A retrospective case-control study was conducted to analyze the clinical data of 94 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from July 2017 to June 2018,including 24 males and 70 females aged 76-98 years[(83.7±5.4)years]. There were 54 patients with intertrochanteric fracture and 40 patients with femoral neck fracture. Surgical method was proximal femoral nail antirotation(PFNA)fixation or artificial hip arthroplasty. A total of 44 patients were managed by ERAS(enhanced recovery group)and 50 patients by traditional nursing(traditional rehabilitation group). The off-bed time was compared between the two groups from aspects of different fracture sites,bone mineral density and causes of injury. The visual analogue scale(VAS)was tested preoperatively and at postoperative days 1,3 and 7. The complications were recorded at postoperative 1 month. The activity of daily living(ADL)score was assessed preoperatively and at postoperative 1 week,1 month and 3 months. The Harris hip score was assessed at postoperative 1 week,1 month,3 months and at the last follow-up. The length of hospital stay and death at postoperative 3 months and at the last follow-up were recorded.Results:All patients were followed up for 12-24 months[(17.7±6.2)months]. In enhanced recovery group,the off-bed time of patients with different fracture sites(femoral neck,femoral intertrochanter),bone mineral density(>-2.5 SD,≤-2.5 SD)and causes of injury(falls,traffic accidents and others)were markedly shortened as compared with traditional rehabilitation group( P<0.01). There was no significant difference in VAS between the two groups before operation( P>0.05). However,the VAS in enhanced recovery group was(3.4±0.9)points,(2.7±0.5)points,(1.7±0.6)points at postoperative days 1,3 and 7,significantly lower than that in traditional rehabilitation group[(4.3±1.1)points,(3.5±0.5)points,(2.7±0.9)points]( P<0.01). One month after operation,the incidence of pulmonary infection was 0% in enhanced recovery group and 28%(14/50)in traditional rehabilitation group( P<0.01). While there showed no significant differences in incidences of cardiovascular system,nervous system,urinary tract infection,lower limb deep vein thrombosis,impaired liver and kidney function,anemia,electrolyte disorder or hypoalbuminemia between the two groups( P>0.05). There was no significant difference in preoperative ADL score between the two groups( P>0.05). The ADL score in enhanced recovery group was(37.0±6.6)points,(70.1±8.4)points,(86.2±9.3)points at postoperative 1 week,1 month and 3 months,significantly higher than that in traditional rehabilitation group[(26.5±10.4)points,(50.1±11.4)points,(70.7±9.0)points]( P<0.01). The Harris hip score in enhanced recovery group was(80.9±8.6)points at postoperative 1 month,significantly higher than that in traditional rehabilitation group[(71.1±9.2)points]( P<0.01). There were no significant differences in Harris hip score between the two groups at postoperative 1 week,3 months and at the last follow-up( P>0.05). The length of hospital stay was(4.7±2.4)days in enhanced recovery group,significantly shorter than(7.8±3.9)days in traditional rehabilitation group( P<0.01). The enhanced recovery group showed no death within 3 months after operation and 2 deaths[5%(2/44)]at the last follow-up,while the traditional rehabilitation group revealed 4 deaths[8%(4/50)]within 3 months after operation. There was no significant difference in the mortality between the two groups until the last follow-up( P>0.05). Conclusion:For elderly patients with hip fracture,perioperative ERAS management model can effectively shorten periods in bed,relieve postoperative pain,reduce incidence of postoperative pulmonary infection,accelerate recovery of hip function,improve quality of life,shorten length of hospitalization and promote early recovery.

13.
Chinese Critical Care Medicine ; (12): 1063-1068, 2021.
Article in Chinese | WPRIM | ID: wpr-909453

ABSTRACT

Objective:To analyze the differences and similarities of pre-treatment and post-treatment lung microbiome of acute respiratory distress syndrome (ARDS) and find out the change rules of the lung microbiome in the progression of ARDS according to different prognosis.Methods:A retrospective study was conducted. Patients with ARDS caused by severe pneumonia admitted to intensive care unit (ICU) of Jiangmen Central Hospital from February 2019 to January 2020 were enrolled as the study subjects. The patients were divided into pre-treatment (ARDS-preT) group (24 cases), post-treatment survival (ARDS-poT-Survival) group (17 cases), and post-treatment death (ARDS-poT-Dead) group (7 cases). ICU patients with mild pulmonary infection and non-ARDS admitted to ICU during the same period were enrolled as control group (25 cases). The similarities and differences of lung microbiome in four groups were analyzed and compared, and the possible pathogenic bacteria (potential risk factors for death) and probiotics (potential survival and protective factors) related to death caused by ARDS were screened.Results:In terms of pathogenic microorganisms, the positive rates of Escherichia coli and Candida albicans in the ARDS-poT-Dead group were significantly higher than those in the ARDS-poT-Survival group [57.1% (4/7) vs. 5.9% (1/17) and 57.1% (4/7) vs. 0% (0/7), both P < 0.05]. In the screening of background bacteria, the decrease of bacteria in the ARDS-preT group compared with the ARDS-poT-Survival group, the ARDS-poT-Dead group compared with the ARDS-poT-Survival group, the ARDS-poT-Dead group compared with the control group, the reduced bacteria might be pulmonary probiotics (potential protective factor for ARDS). The screening result was Hydrobacter [ARDS-preT group vs. ARDS-poT-Survival group: 62.5% (15/24) vs. 94.1% (16/17); ARDS-poT-Dead group vs. ARDS-poT-Survival group: 14.3% (1/7) vs. 94.1% (16/17); ARDS-poT-Dead vs. control: 14.3% (1/7) vs. 96.0% (24/25), all P < 0.05]. In the screening of background bacteria, the increase of bacteria in the ARDS-poT-Dead group compared with the ARDS-preT group, the ARDS-poT-Dead group compared with the ARDS-poT-Survival group, the ARDS-poT-Dead group compared with the control group, and the increased bacteria might be potential pulmonary pathogen (potential risk factor for death of ARDS), which belonged to Enterobacteria: Edwardsiella, Enterobacteriaceae, Escherichia, Klebsiella, Kluyvera, Lelliottia, Pantoea, Raoultella. Conclusions:The results revealed the increase of Escherichia coli or Candida albicans in pulmonary pathogenic microorganisms, or the increase of Enterobacteria in background bacteria may be the risk factors for the death of ARDS. Additionally, background bacteria Hydrobacter probably is a protective factor for the survival of ARDS. Whether it can be used as a novel treatment for ARDS is worth further investigation.

14.
Chinese Critical Care Medicine ; (12): 871-875, 2021.
Article in Chinese | WPRIM | ID: wpr-909420

ABSTRACT

Objective:To evaluate the intestinal function in rats with exertional heat stroke (EHS) and explore the protective role of Ruifuping pectin (RFP) against heat related intestinal mucosal injury.Methods:One hundred and twenty healthy special pathogen free (SPF) male Sprague-Dawley (SD) rats were randomly divided into normothermic control group, EHS model group, hyperthermic plus drinking water group (H 2O+EHS group) and hyperthermic plus pectin group (RFP+EHS group) with 30 rats in each group. The rats in the H 2O+EHS group and RFP+EHS group were given water 20 mL/kg or RFP 20 mL/kg orally for 5 days during adaptive training period. After 1 week, the temperature control range was adjusted to (37±1)℃ using the temperature control treadmill, and the rat model of EHS was reproduced by one-time high temperature exhaustive exercise. No rehydration intervention was given during the training adaptation period in the EHS model group. The rats in the normothermic control group were maintained to room temperature (25±2)℃ and humidity (55±5)% without other treatment. Behavior tests including withdraw response, righting, and muscle strength were performed immediately after onset of EHS. Blood of inferior vena cava was collected, and the serum inflammatory cytokines [tumor necrosis factor-α (TNF-α) and interleukins (IL-6, IL-1β, IL-10)] and activity of diamine oxidase (DAO) were detected by enzyme linked immunosorbent assay (ELISA). The intestinal mucosa was collected, after hematoxylin-eosin (HE) staining, and Chiu score was performed to assess EHS induced pathological changes under light microscope. Results:The rats in the EHS model group had behavioral, inflammatory and pathological changes, such as delayed withdraw response and righting, decreased forelimb pulling, increased inflammatory index, and obvious intestinal mucosal injury, which indicated that the reproduction of the EHS model was successful. There was no significant difference in above parameters between the H 2O+EHS group and the EHS model group except that the inflammatory index in the RFP+EHS group was improved. Compared with the EHS model group, the withdraw reflex to pain and righting after RFP pretreatment in the RFP+EHS group were significantly improved (righting score: 1.4±0.2 vs. 0.3±0.2, withdraw reflex to pain score: 1.0±0.1 vs. 0.2±0.1, both P < 0.05), the muscle strength was significantly increased (N: 13.0±0.5 vs. 8.2±0.6, P < 0.01). The levels of pro-inflammatory factors in the RFP+EHS group were significantly lower than those in the EHS model group [TNF-α (ng/L): 67.5±9.2 vs. 194.3±13.7, IL-6 (ng/L): 360.0±54.1 vs. 981.2±84.4, IL-1β (ng/L): 33.7±9.0 vs. 88.7±6.1, all P < 0.01], while the level of anti-inflammatory factor IL-10 was higher than that in the EHS model group (ng/L: 208.7±10.5 vs. 103.7±7.0, P < 0.01). The degree of intestinal mucosal injury in the RFP+EHS group was less severe than that in the EHS model group, and the Chiu score and DAO were significantly lower than those in the EHS model group [Chiu score: 1.5±0.2 vs. 3.8±0.0, DAO (U/L): 83.7±6.7 vs. 128.7±10.5, both P < 0.05]. Conclusions:High temperature training can damage the intestinal barrier function, and induce endotoxemia and systemic inflammatory response syndrome (SIRS) in rats. Oral prophylactic RFP can protect the intestinal barrier function, alleviate SIRS, and promote the recovery of basic nerve reflex and muscle strength after the occurrence of EHS in rats.

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Chinese Critical Care Medicine ; (12): 692-696, 2021.
Article in Chinese | WPRIM | ID: wpr-909386

ABSTRACT

Objective:To observe the application effect of high-flow nasal canula oxygen therapy (HFNC) after extubation in patients with mechanical ventilation (MV) in the intensive care unit (ICU).Methods:A prospective study was conducted. From January 2018 to June 2020, 163 MV patients admitted to Yijishan Hospital of Wannan Medical College were enrolled, and they were divided into HFNC group (82 cases) and traditional oxygen therapy group (81 cases) according to the oxygen therapy model. The patients included in the study were given conventional treatment according to their condition. In the HFNC group, oxygen was inhaled by a nasal high-flow humidification therapy instrument. The gas flow was gradually increased from 35 L/min to 60 L/min according to the patient's tolerance, and the temperature was set at 34-37 ℃. The fraction of inspiration oxygen (FiO 2) was set according to the patient's pulse oxygen saturation (SpO 2) and SpO 2 was maintained at 0.95-0.98. A disposable oxygen mask or nasal cannula was used to inhale oxygen in the traditional oxygen therapy group, and the oxygen flow was 5-8 L/min, maintaining the patient's SpO 2 at 0.95-0.98. The differences in MV duration before extubation, total MV duration, intubation time, reintubation time, extubation failure rate, ICU mortality, ICU stay, and in-hospital stay were compared between the two groups, and weaning failure were analyzed. Results:There was no significant differences in MV duration before extubation (days: 4.33±3.83 vs. 4.15±3.03), tracheal intubation duration (days: 4.34±1.87 vs. 4.20±3.35), ICU mortality [4.9% (4/82) vs. 3.7% (3/81)] and in-hospital stay [days: 28.93 (15.00, 32.00) vs. 27.69 (15.00, 38.00)] between HFNC group and traditional oxygen therapy group (all P > 0.05). The total MV duration in the HFNC group (days: 4.48±2.43 vs. 5.67±3.84) and ICU stay [days: 6.57 (4.00, 7.00) vs. 7.74 (5.00, 9.00)] were significantly shorter than those in the traditional oxygen therapy group, the reintubation duration of the HFNC group was significantly longer than that of the traditional oxygen therapy group (hours: 35.75±10.15 vs. 19.92±13.12), and the weaning failure rate was significantly lower than that of the traditional oxygen therapy group [4.9% (4/82) vs. 16.0% (13/81), all P < 0.05]. Among the reasons for weaning failure traditional oxygen therapy group had lower ability of airway secretion clearance than that of the HFNC group [8.64% (7/81) vs. 0% (0/82), P < 0.05], there was no statistically differences in the morbidity of heart failure, respiratory muscle weakness, hypoxemia, and change of consciousness between the two groups. Conclusion:For MV patients in the ICU, the sequential application of HFNC after extubation can reduce the rate of weaning failure and the incidence of adverse events, shorten the length of ICU stay.

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Article in Chinese | WPRIM | ID: wpr-908674

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Objective:To analyze the expression of P-selectin and thrombopoietin (TPO) in patients with glioma, and explore their correlation with severity of disease.Methods:One hundred and six patients with glioma who were treated in the Third People's Hospital of Dalian City from June 2017 to June 2019 were selected as the observation group, and 50 physical examination person in the same period were selected as the healthy control group. The clinic data of patients in two groups were analyzed.Results:The serum P-selectin and TPO levels in the observation group were significantly higher than those in the healthy control group: (62.35 ± 16.71) μg/L vs. (25.42 ± 9.18) μg/L, (12.64 ± 3.26) μg/L vs. (6.93 ± 1.77) μg/L ( P<0.01). In patients with different severity of glioma, serum P-selectin and TPO levels in the high-grade group were significantly higher than those in the low-level group: (65.14 ± 17.19) μg/L vs. (53.71 ± 15.26) μg/L, (14.57 ± 3.38) μg/L vs. (9.04 ± 1.97) μg/L ( P<0.01). Serum P-selectin and TPO levels in patients with glioma after treatment were significantly lower than those before treatment: (57.28 ± 16.22) μg/L vs. (62.35 ± 16.71) μg/L, (10.85 ± 2.97) μg/L vs. (12.64 ± 3.26) μg/L ( P<0.01). Spearman correlation analysis result showed that there was a significant positive correlation between serum P-selectin, TPO levels and WHO classification in patients with glioma ( r = 0.417 and 0.361, P<0.05). The results of receiver operating characteristic (ROC) curve analysis showed that the area under curve (AUC) of serum P-selectin in the diagnosis of glioma was 0.859 (95% CI 0.794 to 0.910, P<0.01), the sensitivity was 90.00%, and the specificity was 74.53%. The ROC curve analysis result showed that the AUC of serum TPO in the diagnosis of glioma was 0.720 (95% CI 0.643 to 0.789, P<0.01), the sensitivity was 69.81%, and the specificity was 72.00%. Conclusions:Serum P-selectin and TPO are abnormally expressed in glioma patients, and their level changes are related to the severity of the disease.

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Article in Chinese | WPRIM | ID: wpr-908529

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Objective:To study the characteristics of video electroencephalogram (VEEG) and cranial magnetic resonance imaging (MRI) in neonates with inborn errors of metabolism (IEM) and to determine the predictive value for prognostic.Method:From June 2016 to December 2018, a retrospective study was performed on newborns diagnosed with IEM receiving VEEG examinations at the Neonatology Department of our hospital. VEEG and cranial MRI were used as prognostic indicators and the follow-up results were used as criteria predicting the accuracy of prognosis. The accuracy of the prediction was calculated using a 4 × 4 table.Result:A total of 21 eligible cases with 14 types of IEM were included. The most common type of IEM was organic acidemia (47.6%, 10/21). 16 cases (76.2%) had abnormal VEEG background patterns, including 8 cases of organic acidemia, 3 cases of urea cycle disorders, 1 case of energy metabolism disorder and 4 cases of other IEMs. No significant differences existed in the abnormality rate of VEEG background patterns among these groups ( P=0.882). VEEG showed 3 cases of seizures including 2 cases of electrographic-only seizures. Interburst interval durations were shortened on VEEG background with the decrease of blood ammonia level. The positive predictive values of the moderate-to-severe abnormal VEEG background and the presence of major cerebral lesions on MRI in predicting poor prognosis were 90.0% (95% CI 55.5%~99.7%) and 100% (95% CI 66.4%~100%), respectively, and the negative predictive values were 50.0% (95% CI 18.7%~81.3%) and 85.7% (95% CI 42.1%~99.6%), respectively. Conclusion:Neonates with IEM have higher incidences of abnormal VEEG. Continuous VEEG may accurately diagnose neonatal seizures and effectively monitor brain function. VEEG is a useful tool monitoring infants with IEM and predicting adverse outcomes, especially when used in combination with brain MRI.

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Article in Chinese | WPRIM | ID: wpr-908005

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Seizure is the most common neurological critical disease in the neonatal period, most of which is symptomatic.Seizure is usually caused by acute brain injury, and only electrical seizure is more commonly seen.Neonatal seizures are not easy to be included in the epilepsy classification established by the International League Against Epilepsy (ILAE). As a result, a Neonatal Seizures Task Force was established by the ILAE to develop a modification of the 2017 ILAE classification of seizures and epilepsies.The neonatal classification framework emphasizes the role of electroencephalography (EEG) in the diagnosis of neonatal seizure, which includes a classification of seizure types especially in newborns.The type of seizure in adults and older children mainly depends on clinical characteristics, while many newborns only have electric seizures.Therefore, electric seizures are included in the classification scheme.Clinical events without corresponding EEG changes are not included.Neonatal seizures are all focal seizures, and focal and generalized seizures are unnecessarily to be categorized.Seizures can be classified by abnormal motor episodes (automata, clonic, myoclonic, tonic) and non-motor episodes (autonomic, behavioral changes) or sequential presentation.The new classification can be used to more specifically classify neonatal seizures.

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Article in Chinese | WPRIM | ID: wpr-907862

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Objective:To explore the clinical efficiency evaluation and prognostic factors of aspiration guided by neuronavigation in the treatment of pediatric brain abscess (PBA).Methods:A total of 47 patients with PBA were treated with aspiration guided by neuronavigation between January 2013 and January 2019 at the First Affiliated Hospital of Zhengzhou University.All clinical data were retrospectively analyzed.According to Glasgow Outcome Scale on discharge, all children were divided into 2 groups, namely good prognosis group and poor prognosis group.Prognostic factors were analyzed by using univariate analysis and binary Logistic regression multivariate analysis. Results:Among the 47 children, 38 children (80.9%) were assigned to the good prognosis group, and 9 children (19.1%) were assigned to the poor prognosis group.Univariate analysis proved that abscess volume>4 cm( χ2=5.650, P=0.017), multiple or multilocular abscess ( χ2=3.258, P=0.027), and abscess located in functional areas ( χ2=6.187, P=0.013) were correlated with poor prognosis.Multivariate analysis revealed that abscess volume>4 cm( OR=5.913, 95% CI: 2.241-25.917, P=0.023) and abscess located in functional areas ( OR=10.519, 95% CI: 3.918-62.513, P<0.001) were independent risk factors for poor prognosis. Conclusion:The treatment of PBA with aspiration guided by neuronavigation is safe, effective and minimal invasive, and the clinical efficiency is satisfactory.Abscess volume>4 cm and abscess located in deepbrain/functional areas are independent risk factors for poor prognosis.

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Article in Chinese | WPRIM | ID: wpr-906498

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Objective:To obtain ancient traditional Chinese medicine(TCM)literatures relating to tumor and visual analysis by an automatic framework tool, in order to systematically sort out the development of ancient Chinese medicine oncology. Method:Based on the database platform of ancient TCM books,names of tumor-related diseases in ancient TCM books were retrieved by Selenium WebDriver, an automation framework tool under Python 3.8. Lxml's etree library was used to parse the data. Statistics was made for "classification", "authors", "completion time" and "summary" of relevant ancient books automatically. After the data was checked and processed, Tableau 2019.2 software was used for data visualization analysis. And ancient Chinese medicine literatures relating to tumor were consulted at the database manually,with the dynasties as the clue,and the symptoms,etiology,pathogenesis and prognosis as the emphasis,this paper explores the development process of TCM oncology. Result:A total of 774 349 bytes of text data of 1 128 entries in 242 ancient books were included automatically. According to the findings, there were simple classification and time distribution of tumor diseases in ancient TCM books in the pre-Qin period, with a simple view on the pathogenesis of tumor diseases. From the Han dynasty to the Tang dynasty, the number of relevant literature records and the types and disease names had gradually increased,which further enriched the cognition of tumor nature,signs,classification methods,differential diagnosis;in Song and Ming dynasties,the proportion of Chinese prescription books and surgery books had increased gradually,with the largest number of abdominal organ tumor names among all dynasties;from Qing dynasty to the Republic of China,literatures relating to tumor name and classification were the most improved,and then the TCM tumor syndrome differentiation and treatment system had been formed. Conclusion:It was found that TCM oncology originated in the pre-Qin dynasty,and was improved in the Han and Tang dynasties, mature in the Song and Ming dynasties and completed in the Qing dynasty and the Republic of China. The data visualization method with integrated automation framework and parsing tools is helpful to analyze the subdivision characteristics of ancient TCM literatures,which is convenient,efficient and innovative,in the expectation to provide a classic reference for contemporary TCM studies.

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